Anastomosis In Children Research Articles

Ileal Pouch-Anal Anastomosis in Children with Ulcerative Colitis

This study is a retrospective review of all pediatric patients with ulcerative colitis who underwent colectomy and ileal pouch-anal anastomosis (IPAA) between 1982 and 1992 at the Cleveland Clinic Foundation. The purpose of the review was to determine the effectiveness of IPAA in treating children with ulcerative colitis. Demographic, preoperative, and surgical data were abstracted from archival research of medical records. Quality-of-life information was obtained from patient or parent interviews. Ninety-one children were identified during the study period with a median age of 14.2 years. The principal indication for colectomy was intractable symptoms despite vigorous medical therapy. J-pouches (n = 51) and S-pouches (n = 38) were most commonly constructed. Median follow-up was 1.9 years after ileostomy closure. Thirty early complications (occurring within 30 days of pouch construction) were documented in 21 patients, and 57 late complications (occurring after 30 days) were documented in 34 patients. Small bowel obstruction was the most common early postoperative complication and accounted for 13 of 30 early complications; reoperation was required in four of nine patients. Pouchitis was the most frequent late complication (15 episodes in 12 patients), followed by perineal infection (14 episodes in eight patients), and anastomotic stricture (10 episodes in nine patients). Pouch type, age at colectomy, and disease interval from colectomy to pouch construction were analyzed with relation to the frequency of pouchitis, anastomotic stricture, sepsis, and incontinence. An S-pouch had been used in eight of nine patients with an anastomotic stricture (p = 0.004). The disease interval and age at initial surgery had no bearing on the presence of late complications. The pouches of four female patients were excised as a result of pelvic infection and were subsequently converted to continent ileostomies. Quality-of-life information was obtained for 78 patients. Daytime continence was complete in 67 (86%) children and nocturnal continence was complete in 56 (72%) patients. Seventy-three (94%) patients were very satisfied with their quality of life after IPAA. We conclude that IPAA is an effective surgical procedure for children with ulcerative colitis and results in a relatively normal pattern of defecation with a good long-term functional outcome. Early postoperative complications are common, but only a few patients require further hospitalization or surgery. The most common late complication is pouchitis, which responds to medical treatment. Continence is preserved in the majority of the children, and overall satisfaction with the operation is high.

A rare cause of profound cyanosis after Kawashima modification of bidirectional cavopulmonary anastomosis

The expected level of systemic arterial saturation may not be present after bidirectional superior cavopulmonary anastomosis in children with complex congenital cardiac anomalies. We present a case of persistent severe cyanosis in a patient with azygos continuation of the inferior vena cava after bidirectional superior cavopulmonary anastomosis (Kawashima procedure) due to an intrahepatic venovenous malformation. Subsequent transcatheter deployment of two Rashkind double umbrella devices into the malformation reduced the shunt and markedly improved systemic arterial saturation.

Long-term follow-up of the ileoanal anastomosis in children and young adults : R. Telander, M. Spencer, J. Perrault, et al. Surgery 108:717–725, (October), 1990

Long-term follow-up of the ileoanal anastomosis in children and young adults : R. Telander, M. Spencer, J. Perrault, et al. Surgery 108:717–725, (October), 1990

End-to-end Ureteral Anastomosis in Children With Congenital Mid-Ureteral Stricture

End-to-end Ureteral Anastomosis in Children With Congenital Mid-Ureteral Stricture

A new ‘enterocompressor’ to facilitate rectal anastomosis

A newly devised enterocompressor facilitates low rectal anastomosis in children with Hirschsprung's disease. This simple surgical instrument, composed of two semicylindrical valves, a hinge, and a regulating screw, maintains intestinal anastomoses properly placed and produces spur crushing. In addition, it is inexpensive and reusable. The enterocompressor, used in 33 primary and 15 secondary Duhamel operations, and applied to normalize intestinal transit in 10 colectomies, provided adequate anastomosis and prevented leakage of intestinal contents. This enterocompressor can be used safely in children as young as six months of age.

Ultrasonic Doppler Assessment of Hemodynamics in Extra-Intracranial Arterial Anastomosis in Children with Moyamoya Disease

Ultrasonic Doppler Assessment of Hemodynamics in Extra-Intracranial Arterial Anastomosis in Children with Moyamoya Disease

Modified Rehbein surgical procedure using a surgical staple--progress in the treatment of Hirschsprung disease in children

The particular advantage of using the intraluminal stapler in Rehbein's operation for Hirschsprung's disease is that we are able to achieve very low and safe anastomoses 2-3 cm above the anal verge. Use of the intraluminal stapler has successfully overcome the difficulties of a very low handsewn anastomoses in children. In this way the aganglionosic segment can be resected completely. In 16 infants we can demonstrate the safety and reliability of colorectal anastomoses using the smallest intraluminal circular stapler, 21 mm in diameter. Endoscopic and manometric investigations demonstrate no stenosis or stricture.

Use of a single layer extramucosal suture for intestinal anastomosis in children: A.J.L. Brain and E.M. Kiely. Br J Surg 72:483–484, (June), 1985

Use of a single layer extramucosal suture for intestinal anastomosis in children: A.J.L. Brain and E.M. Kiely. Br J Surg 72:483–484, (June), 1985

Anoneorectal evaluation after colectomy and endorectal ileoanal anastomosis in children and young adults

Recent improvements in the technique of colectomy, rectal mucosectomy, and endorectal ileoanal anastomosis allow a satisfactory result in most patients. However, the clinical outcome is not entirely satisfactory in about 5% to 10% of patients because of excessive stool frequency or episodic fecal incontinence or both. We evaluated anoneorectal function postoperatively to help explain the mechanisms of the difficulties. Six patients with imperfect functional results (group 1) and 6 with good functional results (group 2) after ileoanal anastomosis and closure of the loop ileostomy were compared with 12 healthy volunteers who had not had operation, through a series of tests designed to evaluate anal sphincter and neorectal function. All patients were instructed in balloon dilation of the neorectum to develop a reservoir while awaiting closure of the ileostomy. Anal sphincter manometric measurements of resting and squeeze pressures were obtained with a 4-channel probe attached to a noncompliant pneumohydraulic perfusion system. Incremental inflation of an intraluminal bag while pressures were simultaneously recorded allowed determinations of neorectal capacity and distensibility. The efficiency of neorectal evacuation was assessed by instilling a labeled synthetic viscous load into the distal bowel. Patients in group 1 had lower resting anal pressures (P less than 0.05), lower squeeze pressures (P less than 0.05), smaller neorectal capacities (P = 0.13), and less neorectal distensibility (P = 0.27) than patients in group 2. Furthermore, the values for patients in group 2 closely approximated those found in healthy volunteers.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term results in the treatment of extrahepatic bile duct atresia

This article is intended as a contribution towards the question of long-term results to be expected when using hepato-portodigestive anastomoses in children. The paper is based on analyses of the course of the disease in 683 children, as placed at the author's disposal by paediatricians and paediatric surgeons in Europe, the United States of America, and Japan, as well as on an evaluation of 56 child patients observed by the author himself. This assessment resulted in the formulation of five conditions determining the prognosis. One can expect a 5-year survival rate of 66 per cent with good clinical, laboratory, sonographic and scintiscan data as well as histological findings, provided surgery is possible before 6 weeks after onset of cholestasis (this usually means surgery before the 8th week of life), provided also that cirrhosis has not set in at the time of surgery and that there are no additional numerical and morphological changes of the interlobular bile ducts; furthermore, if the average total diameter of the bile duct structures in the hepatic porta is at least 450 mu, and if no cholangitides occur postoperatively. If these conditions are not fulfilled, prognosis must be considered as poor. Such patients become candidates for a liver transplant, which has a 4-year survival rate of 58 per cent since introduction of the cyclosporin A-low-dose-steroid treatment. The article also discusses questions of organisation and of ethics connected with liver transplantation.

Results of Mesoenterico-caval Anastomosis for Portal Hypertension (author's transl)

16 cases of mesenteric caval anastomosis in children with recurrent bleeding from oesophageal varices are presented. Advantages of this technique include the quick normalisation of portal pressure and the low incidence of thrombosis or recurrent bleeding. This complication arises in 10% of patients treated with a central mesenteric caval shunt. The disadvantage of the technique presented is the reduction of perfusion of the liver and the necessity of ligating the iliac veins. An alternative procedure is spleno-renal shunt but this also leads to a reduction of liver perfusion. An alternative procedure is spleno-renal shunt but this also leads to a reduction of liver perfusion. The incidence of thrombosis and recurrent bleeding is higher using this method and on the whole the choice of technique is determined by the age of the patient.

Surgeon's tactics for relaparotomy after small bowel anastomosis in children

The main complications after resection of the small intestine in 87 out of 560 operated children are described. With peritonitis, which developed as a result of the divergence of the anastomotic sutures, it is preferable to remove the bowel loop carrying the anastomosis to the anterior abdominal wall.

Heart Volume and Haematocrit Value following Aorto-Pulmonary Anastomosis in Children with Fallot's Anomaly

In 16 children with Fallot's anomaly and Waterston anastomosis, the effect of the shunt was examined repeatedly up to 2 years after operation. Change in heart volume was correlated with the haematocrit value. In 14 of the cases the function of the anastomosis was also evaluated on cardioangiography. Serial heart volume measurements were found useful to evaluate the function of the anastomosis.

Ascending aorta-right pulmonary artery anastomosis in children with complex cardiac malformations: Long-term results in 30 cases

In this report, we shall analyze the results obtained with palliative treatment in 30 patients with congenital heart disease who were operated upon at the University Hospital of Caracas during the period 1968 to 1972. In all cases, an ascending aorta-right pulmonary artery anastomosis was performed. Although we believe that the Blalock-Taussig and Potts shunt are satisfactory operations in some cases, at the present time we prefer the aorta-right pulmonary branch anastomosis in Fallots tetralogy and other congenital heart diseases such as single ventricle. In Fallot's tetralogy, particularly, this procedure provides better results, because the anastomosis can be closed through the aorta when these patients are later subjected to total correction with extracorporeal circulation.

Tracheal resection with primary anastomosis in children

We observed nine tracheal stenoses following intensive respiratory care in 524 neonates and infants. For all but four of them, we used medical and endoscopic treatment only, with satisfactory immediate and late results. In four children between 6 and 16 yr, we were obliged to perform a tracheal resection with primary anastomosis. All four children had primary tracheostomies as emergency procedures. Subsequent respiratory distress was the result of a dense fibrotic stenosis resistant to medical and endoscopic management. The technique of resection is described, especially, in dealing with the innominate artery. Three to five rings were resected. Cardiopulmonary bypass, was found to be unnecessary. One patient died 1 mo after operation, from an endoscopic accident. The remaining three had excellent results assessed clinically and by endoscopy and radiocinematography. Iatrogenic tracheal stenosis in children is a serious lesion, which can be prevented by correct intensive respiratory care.